Diotic and Antiphasic Digits-in-noise Testing as a Hearing Screening and Triage Tool to Classify Type of Hearing Loss. 2022

Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, Gauteng, South Africa.

The digits-in-noise test (DIN) is a popular self-test measure that has traditionally been used to screen for hearing loss by providing either a pass or refer result. Standard approaches either tested each ear monaurally or used a binaural diotic version where identical digits and noise were presented simultaneously to both ears. Recently, a dichotic, antiphasic version was developed, increasing sensitivity of the DIN to unilateral or asymmetric sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). The purpose of this study was to determine predictors and normative ranges of the antiphasic and diotic DIN and to determine if a combination of diotic and antiphasic DIN could accurately categorize hearing into (1) normal, (2) bilateral SNHL, or (3) unilateral SNHL or CHL. The analytical sample consisted of 489 participants between the ages of 18 and 92 years with varying types, symmetry, and degrees of hearing loss. Degree and type of hearing loss were determined based on standard clinical four-frequency (0.5-4 kHz) pure-tone air and bone conduction threshold averages. The sample consisted of bilateral normal hearing (n = 293), bilateral SNHL (n = 172), unilateral SNHL (n = 42), and CHL (n = 32). All participants (n = 489) first completed an antiphasic DIN (digit stimuli 180° out-of-phase between ears), while 393 of the sample also completed a diotic DIN. Two procedures were assessed for their ability to categorize hearing into one of the three hearing groups. The first used a fixed antiphasic cutoff combined with a cutoff formed by a linear combination of antiphasic and diotic speech recognition threshold (SRT) or binaural intelligibility-level difference. Poorer ear pure-tone average was the strongest predictor of antiphasic DIN score, whereas better ear pure-tone average explained more of the variance in diotic SRT. The antiphasic DIN sensitivity and specificity was 90% and 84%, respectively, for detecting hearing loss, with outstanding area under the receiver operating characteristics values exceeding 0.93 to identify hearing loss in the poorer ear. The first fixed SRT cutoff procedure could categorize 75% of all participants correctly, while the second procedure increased correct categorization to 79%. False negative rates for both procedures were below 10%. A sequential antiphasic and diotic DIN could categorize hearing to a reasonable degree into three groups of (1) normal hearing; (2) bilateral SNHL; and (3) unilateral asymmetric SNHL or CHL. This type of approach could optimize care pathways using remote and contactless testing, by identifying unilateral SNHL and CHL as cases requiring medical referral. In contrast, bilateral SNHL cases could be referred directly to an audiologist, or nontraditional models like OTC hearing aids.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009622 Noise Any sound which is unwanted or interferes with HEARING other sounds. Noise Pollution,Noises,Pollution, Noise
D003638 Deafness A general term for the complete loss of the ability to hear from both ears. Deafness Permanent,Hearing Loss Permanent,Prelingual Deafness,Deaf Mutism,Deaf-Mutism,Deafness, Acquired,Hearing Loss, Complete,Hearing Loss, Extreme,Acquired Deafness,Complete Hearing Loss,Deafness, Prelingual,Extreme Hearing Loss,Permanent, Deafness,Permanent, Hearing Loss,Permanents, Deafness
D006309 Hearing The ability or act of sensing and transducing ACOUSTIC STIMULATION to the CENTRAL NERVOUS SYSTEM. It is also called audition. Audition
D006312 Hearing Loss, Bilateral Partial hearing loss in both ears. Deafness Bilateral,Bilateral Deafness,Bilateral Hearing Loss,Bilateral Hearing Losses,Bilateral, Deafness,Bilaterals, Deafness,Deafness Bilaterals,Deafness, Bilateral,Loss, Bilateral Hearing
D006314 Hearing Loss, Conductive Hearing loss due to interference with the mechanical reception or amplification of sound to the COCHLEA. The interference is in the outer or middle ear involving the EAR CANAL; TYMPANIC MEMBRANE; or EAR OSSICLES. Conductive Hearing Loss
D006319 Hearing Loss, Sensorineural Hearing loss resulting from damage to the COCHLEA and the sensorineural elements which lie internally beyond the oval and round windows. These elements include the AUDITORY NERVE and its connections in the BRAINSTEM. Deafness Neurosensory,Deafness, Neurosensory,Deafness, Sensoryneural,Neurosensory Deafness,Sensorineural Hearing Loss,Sensoryneural Deafness,Cochlear Hearing Loss,Hearing Loss, Cochlear,Deafnesses, Neurosensory,Deafnesses, Sensoryneural,Neurosensory Deafnesses,Sensoryneural Deafness,Sensoryneural Deafnesses
D006320 Hearing Tests Part of an ear examination that measures the ability of sound to reach the brain. Hearing in Noise Test,Quick Speech-in Noise Test (QuickSIN),Real Ear Measurement,Speech in Noise Hearing Test,Ear Measurement, Real,Ear Measurements, Real,Hearing Test,Measurement, Real Ear,Measurements, Real Ear,Quick Speech in Noise Test (QuickSIN),Real Ear Measurements,Test, Hearing,Tests, Hearing
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths

Related Publications

Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
November 2023, International journal of audiology,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
April 2024, Audiology research,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
November 2025, International journal of audiology,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
January 2001, Noise & health,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
June 2020, Journal of Korean medical science,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
January 2021, Ear and hearing,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
September 2025, Journal of Alzheimer's disease : JAD,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
January 2016, Ear and hearing,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
January 2016, B-ENT,
Karina C De Sousa, and Cas Smits, and David R Moore, and Hermanus C Myburgh, and De Wet Swanepoel
August 2015, Journal of the Association for Research in Otolaryngology : JARO,
Copied contents to your clipboard!